It's a world of pain out there. Or at least that's how it seems from in here in front of the telly. Take, for example, the BBC's Tuesday peak viewing. On BBC1 there was Spoilt Rotten, a Panorama special on Liverpool's Alder Hey children's hospital, which featured several scenes of small children having their teeth pulled out. If that didn't appeal to you, over on BBC2 was the second part of the remarkable documentary series on London's Great Ormond Street children's hospital, which featured small children on ventilators slowly losing the battle to live. The combined effect almost achieved the impossible and made The Bill on ITV1 seem like an attractive option.

Short of visiting a torture chamber, there's probably no more reliable means of capturing the drama of human despair than sticking a camera in a children's hospital. But if you did want to make extra certain, then you'd probably opt for the intensive care unit. After the punishing visit to the cardiac unit, where we witnessed an anxious nine-year-old's last moments before a failed heart transplant, last week it was off to the ICU, where suffering is as routine as the doctors' rounds.

There is something innately unfair about documentaries on children's hospitals, of which there has been no shortage over the years. They don't leave the viewer, let alone the critic, a great deal of choice. The challenge is not to the heart – because who can remain detached in the face of a child's impending death? – but to the stomach. You're bound to feel, the question is whether you can bear to watch.

To its credit, Great Ormond Street avoided the sentimentality and emotive cliches that tend to accompany camera crews to children's wards. It was instructive without ever appearing intrusive. The real strength of the programme lay in its focus on the professional, parental and moral dilemmas created by modern medical science. When it's possible to keep a terminally ill child alive for ever longer periods, at what point should the hospital give up and devote scarce resources to more viable patients? Or, as the lead consultant put it, "what's futility?"

It's certainly not a word that parents rush to employ when it's their children whose lives are in the balance. Thus many children are put through gruelling operations before succumbing to death. It's a process that is hard enough to glimpse, let alone to be a part of. One of the premature babies followed by the film showed signs of rallying and then suddenly expired. So crushing was this turn of events that it seemed the filmmakers had invented a whole new genre: tragedy over triumph.

When another mother ignored expert opinion and demanded further surgery for her baby daughter, her wilfulness appeared to border on the callous.

"I take what they say with a pinch of salt," she said, dismissing the doctors' prognosis. But she was right and they were wrong. Her daughter survived the operation she insisted upon and showed signs of thriving.

Resisting medical advice in such circumstances could be seen as a victory of love over reason, but in Panorama: Spoilt Rotten, which detailed an epidemic of preventable child illnesses, we saw the defeat of sense by stupidity. According to the film, a generation of children have been reared on a diet of cakes and fizzy drinks as if the idea that sugar caused tooth decay was put about by the tooth fairy.

Perhaps the most striking case involved a five-year-old boy whose weight was that of an average 17-year-old. His mother pushed him home from school in a wheelchair, and fed him like a veal calf. Yet she maintained that his obesity was "genetic". In a way she was right. The genetic disorder from which the boy was suffering was his mother's myopic love.

By contrast, Young, Autistic and Stagestruck (Channel Four) was almost, but not quite, light relief. Nine young people from across the autistic spectrum, of a variety of ages, were brought together to produce a stage show. To get some idea of the formidable task ahead, it's fair to say that the only previous creativity one of nine had demonstrated was smearing his own excrement around the bathroom.

In many ways, autism seems too broad a church for such an experiment. After all, what has a boy who can scarcely speak in common with 12-year-old Ben, a fiercely intelligent child who essayed the sharpest definition of the difference between Asperger's syndrome and autism that I've ever heard? The first episode of the programme didn't answer that question, but it did enough to suggest that on this occasion tragedy was going to revert to triumph.

Triumph as tragedy might be a way of describing the self-distortion masquerading as self-empowerment that was the subject of The World's Strangest Plastic Surgery and Me (Channel Four). Actually, that wasn't the subject, it was merely the rationale or excuse for what was in reality a Victorian freak show with a touch of modern irony thrown in for fashion's sake.

The "Me" in the title was the chronically insincere Mark Dolan – imagine Louis Theroux after having undergone plastic surgery on his soul. He interviewed the kind of people whose main aim in life is to appear on shows such as this, including the obligatory brainless American blonde with massive breast implants and no discernible nose. After 43 different cosmetic procedures, Jenny Lee looked like a car crash in which both airbags had successfully inflated. She looked, in other words, like a Californian.

Dolan also met a Native American called Stalking Cat who had his face surgically altered to resemble a cat. In the event he bore an uncanny resemblance to Bert Lahr in The Wizard of Oz. They all had their sad stories but Dolan seemed more interested in affecting a concern that his continual smirking at the camera suggested was as cosmetic as the golfballs that doubled for Jenny's cheekbones.

According to the extraordinary Welcome to Lagos (BBC 2), in Nigeria the rubbish heap isn't the terminus of failure, but the starting point for enterprise.

The film followed the self-styled scavengers of the giant Olusosun rubbish tip, where a whole micro economy thrives in the most unpromising circumstances. Everyone spoke in that baroquely bureaucratic English that is almost as profound as it is comic.

"This is where you can see the unity of the Nigerian people in manifestation," said Eric, a scavenger-cum-rapper, while receiving a post-work manicure. Shortly afterwards, he blinded a fellow scavenger in a brutal fight. If the removal of his colleague's eye appeared to undermine Eric's vision of solidarity, his co-workers came to his philosophical rescue. By raising the money to pay his victim's compensation, Lagos's scavengers showed that even in this Darwinian dystopia, the fittest survive by supporting each other.

In A Passionate Woman (BBC1) Billy Piper played a frustrated woman married to a dull man who behaved as though he had a pole up his bottom. But her life found dramatic purpose when a handsome eastern European émigré moved into the flat downstairs. Suddenly she was the one with a Pole up her. I shall return to this drama next week, following the concluding part today.

In the meantime, it's enough to say that there is no pain more penetrating than that which is born of romantic pleasure.

Scene of the week

Standing at their lecterns on a stage with a backdrop like a computer screen saver, the three party leaders in
The First Election Debate (ITV1)
resembled nothing so much as contestants in a special political version of
The Weakest Link. If we imagine the tenacious Alastair Stewart as a more ebullient Anne Robinson without a facelift, then the picture of the game show is almost complete. The one difference was that there was no head-to-head, which was just as well for Gordon Brown, who probably was the weakest link.

Rather than belittling the event, seeing the debate in terms of a game show actually serves to show the scale of the trio's achievement. Most people competing in front of a TV studio audience struggle to remember the capital of Canada. But these guys answered a rapid succession of questions on everything from immigration to elderly care reform without hesitation – albeit with some deviation and repetition – and without ever losing their respective threads. You only have to try the thought experiment of placing any American president, and particularly George Bush, in that position to recognise what could have gone wrong. And yet it's the British who for decades have resisted televised debates.

Let's for once give ourselves a collective slap on the back. OK, we might no longer manufacture anything, our football teams have crashed out of Europe, and the country as a whole looks like it's been dragged through a hedge fund backwards, but in the best tradition of Mrs Merton, we certainly do know how to have a heated debate.